Polyneuropathy & hind limb weakness

[lehughes]

2. Tuxedo
Tuxedo, 4 years old MN Domestic Shorthaired Cat, presents Polyneuropathy of unknown cause; Hindlimb weakness and tremoring, plantigrade stance; Carpal hyperextension, and FeLV positive. On PE, he demonstrates the above but does not appear to be painful. Please see video attached. O relates that he does seem painful at times and will not take the stairs up at all.

Would it be possible to strengthen the ligaments at this age?

From his neurologist:
Laboratory Analysis: 1) Cryptococcus/coronavirus titer (January 23, 2018, performed by Dr. Wong): Results pending at the time of discharge. 2) Urine metabolic screen (January 23, 2018, performed by Dr. Wong): Results pending at the time of discharge.
Tuxedo's neurologic examination findings suggest a problem affecting the peripheral nervous system as the cause of his difficulty walking. The peripheral nervous system includes the motor neurons, nerve roots, nerves, neuromuscular junction and the muscles. There are nerves that supply the limbs as well as nerves that supply the larynx, pharynx and esophagus. When the peripheral nerves are affected, clinical signs include weakness, wobbliness and sometimes signs such as changes in the bark and hoaresness. The classic presentation of a polyneuropathy is a several month hisotyr of progressive weakness in all four legs, atrophy of the muscles, lack of spinal pain, and changes in vocalization (meow or bark).

VIDEO: https://youtu.be/f_1vqjIex-A
(note you likely need to cut and past this into the URL bar.)


Jessica Dreyfus, DVM

[lehughes]

Hey Jessie,

So my first thought was 'sure, you can strengthen (muscles... not ligaments per se).

But then I was reminded of a case I saw last week with a partial gastrocs tear with a dropped hock (and the feeling that some muscle had balled up in the gastrocs region). Dropped hock is often indicative of a musculotendinous junction tear versus teno-osseus.

So it could be that this is more than just laxity. Perhaps it has progressed to a tear.

Sadly, it's a young cat. If he was older, I'd be inclined to say, just work on function and treat the secondary issues. Since he's young, I guess you put some kind of a brace into your thought processing. Since it would be permanent, then I'd look into Hero or Orthopets for the rear legs. (Discount for FourLeg members if using Hero). Maybe a carpoflex from Therapaw for the carpals.

My personal opinion would be to work with function, and build strength as best you can (UWT? Swimming?) Where would you stop in regards to bracing, propping up, dealing with sores as they came and new joints having troubles and needing splints / braces on all 4 legs. I would bring this up with the owners in a very open discussion about options however. So that they are part of the decision making

I'd also reserve judgement on whether he has pain or not based on the owner's perception. I have had plenty of discussions with owners where sometimes they do not recognize a behaviour as pain, and other times where they totally misinterpret something as pain. So, continue to monitor that for yourself and/or have the owner video the cat at a time where they think he's painful - so that YOU can be objective. Perhaps it's just weakness (especially if he has bilateral partial achilles tears.)

I'm not sure this helps. We all want something magical for these difficult cases. But sometimes there's just helping with function and no real 'correction' of the issue.

All the best!

Laurie